Métastases du système nerveux central: Central nervous system metastases

Abstract

Lung cancer is the leading provider of brain metastases (BMs). The prevalence of BMs varies depending on pathology and can occur in up to 50% of non-small cell lung cancers (NSCLC) and 80% of small cell lung cancers (SCLC) during follow-up. BMs prevalence is also higher in case of oncogenic addictions such as EGFR mutations or ALK rearrangements. Furthermore, BMs result in significant morbidity and mortality. They are directly responsible for death in 50% of cases.BMs evolution and response to treatments is heterogeneous, and can be different from the primary tumor. This is due to molecular differences between BMs and primary tumors related to the blood-brain barrier (BBB) but also to a very different tumor microenvironment.Depending on pathology, tumor mutation profile and PDL1 expression, systemic treatments may be based on immunotherapy alone, a combination of chemotherapy and immunotherapy, or targeted therapies. More and more data are available on intracranial response of systemic treatments, including data for new treatments in development. In addition to systemic treatments, local treatments such as surgery, whole brain radio therapy (WBRT) or stereotactic radiotherapy (SBRT) should be considered. Local treatment choice mainly depends on the number and volume of brain lesions. Because of fewer side effects, SBRT is becoming an increasingly important part of treatment. On the contrary, prophylactic cranial irradiation is limited to SCLCs with good response to chemotherapy.1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.